NCBW Omaha Application Form

National Coalition of 100 Black Women

Omaha Metropolitan Chapter

Membership Application

Thank you for your interest in the NC100BW Omaha Metropolitan Chapter. We invite you to complete this application as a request for membership in the Chapter.

Name

Address

Home #

Work # Cell #

E-mail

Present Occupation

Present Employer

Individual Assessment

1. What is your organizational experience? Check the appropriate box(es) below and elaborate in the space provided.

2. I can be contacted at:

3. I am free to travel:

4. What are your specific skills and experiences that will advance the organizational agenda? (Please check all that apply and elaborate in the space provided)

5. As a member of the local NC100BW Chapter, in what area(s) do you have a desire to work to advance our local agenda?

6. How much time can you devote during the next 2 years to help the organization realize its full potential?

Other(specify)

7. What do you feel are the 2–3 most important things NC100BW-Omaha Chapter should do over the next 2 years to realize its full organizational potential?

8. Do you have corporate, local, national, and political, media or foundation contacts that you would be willing to call on behalf of NCBW. Please offer specific examples:

9. What skills and or talents would you bring to enhance the development and success of the Greater Omaha Chapter of the National Coalition of 100 Black Women?

10. Describe your greatest community leadership contribution?

Attitudinal Evaluation

1. List and explain three attributes that you posses and how these attributes would benefit you in becoming an effective member of this Chapter?

2. What is the most significant challenge facing Omaha and why?

3. List the most notable strength(s) of Omaha, and how the Greater Omaha Metropolitan Chapter of the National Coalition of 100 Black Women can help to strengthen or highlight them?

4. Explain why you are interested in becoming a member of the Greater Omaha Metropolitan Chapter of the National Coalition of 100 Black Women?